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PubMed1990

Intraglandular tumor extent and prognosis in prostatic carcinoma: application of a grid method to prostatectomy specimens.

The extent of tumor in prostatectomy specimens was determined by a grid method in 117 patients with prostatic adenocarcinoma. A plastic strip or ruler with squares of 3.0 mm was used, and the ratio of squares overlying carcinoma to the total number of squares overlying prostate tissue was calculated. This grid ratio, which represents an estimate of the percentage of the prostate involved by tumor, was a significant prognosticator closely tied to the likelihood of tumor progression and to survival time, as assessed by logistic regression analysis and a proportional hazard model. The grid ratio was better than histologic grade in predicting tumor progression and patient survival; also, the ratio was more objective than histologic grade as judged by interobserver agreement values. Only slight improvement in prognostication was obtained with concurrent use of both extent and grade. The grid ratio method was slightly better in predicting tumor progression and patient survival than a second method of assessing the percentage of prostatic tissue involved by tumor, the pathologist's percentage estimate. These results indicate that it is important to quantitate tumor extent within prostatectomy specimens; such quantitation need not require step-sectioning of the entire prostate and an expensive and time-consuming method such as computerized morphometrics but rather may be performed by a simple estimate of the percentage of the prostate involved by tumor. Reporting of histologic grade and tumor extent in the prostate gland is recommended as both appear to be important in identifying those patients at risk for a poor outcome after prostatectomy for prostatic carcinoma.

Adenocarcinoma↗
PubMed1998

Influence of prostate-specific antigen testing on the spectrum of patients with prostate cancer undergoing radical prostatectomy at a large referral practice.

OBJECTIVE: To analyze trends in the clinical stage and pathologic outcome of patients with prostate cancer who underwent radical prostatectomy at a large referral practice during the prostate-specific antigen (PSA) testing era. MATERIAL AND METHODS: Between January 1987 and June 1995, 5,568 patients with prostate cancer (4,774 with clinically localized disease of stage T2c or less) underwent pelvic lymphadenectomy and radical retropubic prostatectomy at our institution. Patient age, preoperative serum PSA level, clinical stage, pathologic stage, Gleason score, and tumor ploidy were assessed. Outcome was based on clinical and PSA (increases in PSA level of 0.2 ng/mL or more) progression-free survival. RESULTS: Patient age (65 to 63 years old; P<0.001) and serum PSA level (median, 8.4 to 6.8 ng/mL; P<0.001) decreased during the study period. The percentage of patients with clinical stage T1c prostate cancer increased from 2.1% in 1987 to 36.4% in 1995 (P<0.001), and clinical stage T3 cancer decreased from 25.3% to 6.5% (P<0.001). Nondiploid tumors decreased from 38.3% to 24.6% (P<0.001), and the proportion of patients with pathologically organ-confined disease increased from 54.9% to 74.3% (P<0.001). More cT1c than cT2 tumors were diploid (80% versus 72%; P<0.001), had a Gleason score of 7 or less (75% versus 65%; P<0.001), and were confined to the prostate (75% versus 57%; P<0.001). Five-year progression-free survival was 85% and 76% for patients with clinical stage T1c and T2, respectively (P<0.001). CONCLUSION: Since the advent of PSA testing, patients referred to our institution for radical prostatectomy have shown a significant migration to lower-stage, less-nondiploid, more often organ-confined prostate cancer at the time of initial assessment. Cancer-free survival associated with PSA-detected cancer (cT1c) is superior to that with palpable tumors (cT2). Whether these trends translate into improved long-term cancer-specific survival remains to be confirmed with longer follow-up.

Adult↗
PubMed2003

Comparison of the effects of two intrathecal anaesthetic techniques for transurethral prostatectomy on haemodynamic and pulmonary function.

BACKGROUND AND OBJECTIVE: Transurethral prostatectomy is routinely performed under spinal anaesthesia. This technique can cause hypotension, which is particularly undesirable in the elderly. The objective was to compare spinal anaesthesia for transurethral prostatectomy using hyperbaric bupivacaine 15 mg (control group) and hyperbaric bupivacaine 10 mg (limiting spread by maintaining the upright position for 15 min) and fentanyl 25 microg (fentanyl group) in terms of haemodynamic and pulmonary function. METHODS: Thirty ASA I-III patients were randomly selected and underwent spinal anaesthesia with either hyperbaric bupivacaine 15 mg (immediately positioned supine) or hyperbaric bupivacaine 10 mg (upright for 15 min) and fentanyl 25 microg. RESULTS: The greatest changes in mean arterial pressure (P = 0.9), ephedrine requirements (P = 0.8) and mean maximum change in forced vital capacity (P = 0.5) were similar in both groups. CONCLUSIONS: The addition of fentanyl 25 microg to bupivacaine 10 mg and limiting the spread of the block does not improve either haemodynamic or pulmonary function compared with bupivacaine 15 mg in patients undergoing transurethral prostatectomy.

Adjuvants, Anesthesia↗
PubMed1999

Is invasive anesthetic monitoring necessary during radical prostatectomy?

The purpose of this study was to obtain objective information on the necessity of invasive anesthetic monitoring during radical prostatectomy. We reviewed retrospectively the charts of 257 patients undergoing radical prostatectomy on an established pathway which did not include the intraoperative use of an arterial line or central venous catheter. Outcome measures including intraoperative vital signs, cardiac arrhythmias, blood loss and fluid management were assessed. In particular, we sought to determine situations in which insertion of monitoring devices was required because of an unanticipated intraoperative event. The patient ages ranged from 40 to 75 y with a mean of 60.3 y. The mean estimated blood loss was 546.9 cm(3) (median 500 cm(3)). Thirty-eight patients had a measured intraoperative systolic blood pressure of <90 mmHg, but no hypotensive episodes required any treatment other than fluid administration. A single patient required pharmacologic therapy for hypertension. One patient received intravenous lidocaine because of premature ventricular contractions, but no other arrhythmias were observed. No patient required intraoperative insertion of an arterial line or central venous catheter. These data provide objective evidence for the abandonment of routine use of central venous catheters or arterial lines during radical prostatectomy. This avoids not only the expense of these maneuvers, but also the potential morbidity of unnecessary invasive medical procedures.

Journal Article↗
PubMed2001

A population-based study on radical prostatectomy in France.

There has as yet been no descriptive study of the practice of radical prostatectomy in the general population in France. The objective of this work was to investigate the use of radical prostatectomy (RP) in France and its determinants and geographic variations. A total of 175 radical prostatectomies was identified in a random sample of 798 cases of prostate cancer recorded in 1995 by four cancer registries, in the departments of Bas-Rhin, Calvados, Isère and Tarn. Tumour characteristics, diagnostic procedures and histopathological results were analysed. Multivariate analysis by logistic regression was used to take into account age, prostate specific antigen (PSA) levels and clinical stage in order to study variations between geographical departments and sectors of activity (private or public). The mean age of the patients at the time of diagnosis was 65.3 y (range 46-76). Median PSA level was 18.2 ng/ml (range 1-184). Diagnosis was made by randomised biopsies in 73.8% of cases or by transurethral resection (6.9%). Clinical stage was classified T(1) (22.3%), T(2) (64%), T(3) (8.6%), N(+) (0.6%) and unknown (4.5%). The histopathological result was pT(2)N0 in 46.3% of cases, pT(3)N0 in 40%, pT(4)N0 in 1.7%, pT(x)N(+) in 8.6% and unknown in 3.4%. Adjuvant therapy (radiotherapy 13.7%, hormonal treatment 13.7% or both 3%) was administered in 54 patients (31%). Logistic regression showed that the probability of undergoing RP was three times higher in one department than in the other departments, and was 2.6 times as high in the private sector. This study on the practice of RP is the first performed in the general population in France. It shows that practice differs according to geographical region and sector of activity, indicating that schools of thought and medical culture vary within the same country.Prostate Cnacer and Prostatic diseases (2001) 4, 118-123

Journal Article↗
PubMed2005

Laparoscopic radical prostatectomy--impact of training and supervision.

To define the influence of training and supervision on the quality of laparoscopic radical prostatectomy we compared our perioperative parameters, as well as the postoperative functional and oncological outcomes of four generations of surgeons with significantly different training modalities. The first two generations were trained in open retropubic radical prostatectomy, but the third and fourth generation were trained mostly laparoscopically. Overall the data of more than 1000 performed cases were compared: We could not find any significant difference concerning our complication rates. Also the data of oncological (positive margins) and functional results (data of continence with a follow-up of more than two years) were comparable within all groups. A learning curve was observed only for the operating time, but proved to be significantly shorter for the third and fourth generations. Therefore we can conclude that the quality of laparoscopic radical prostatectomy does not depend on the individual experience in open surgery but to a considerable extent on the quality of laparoscopic education (e.g. simulation trainer, supervision).

Journal Article↗
PubMed1997

Estimation of tumor volume in radical prostatectomy specimens in routine clinical practice.

Tumor volume may be an independent prognostic factor in prostatic adenocarcinoma but is too difficult, expensive, and time consuming to measure in routine clinical practice. We sought to evaluate several simple estimates of tumor volume in radical prostatectomy specimens. Specimens from 86 radical prostatectomies were completely sectioned, and the true tumor was volume calculated using a computer-assisted image analysis technique. True tumor volume was then compared with the results of several estimation techniques. True tumor volume ranged from 0.004 to 9.74 cc (mean, 1.59 cc). The Pearson correlation coefficient of the length of the maximum dimension of tumor as measured from the slide with true tumor volume had an r2 of 0.688. However, 15 (75%) of 20 tumors less than 0.5 cc had a single maximum diameter of less than 10 mm, and only 3 (4%) of 66 tumors with volumes greater than 0.5 cc had a maximum diameter of less than 10 mm. Fifteen (68%) of 22 tumors with true tumor volumes greater than 2 cc had a maximum dimension greater than 20 mm, and only 2 (3%) of 64 tumors with volumes less than 2 cc had a maximum dimension greater than 20 mm. Increasing correlation with true tumor volume could be obtained from the largest single tumor area (r2 = 0.749), the sum of the largest dimensions of two separate tumor foci (r2 = 0.759), and the sum of the two largest areas (r2 = 0.859). For tumors with true volumes less than 0.5 cc, only 1 (5%) of 20 cases had a sum of the two largest areas greater than 65 mm2, and no tumor larger than 0.5 cc had a sum of less than 65 mm2. For tumors larger than 2 cc, 19 (86%) of 22 tumors had a sum of the two largest areas greater than 250 mm2, and only 1 (2%) of 64 cases with a true tumor volume less than 2 cc had an area greater than 250 mm2. We conclude that tumors in radical prostatectomy specimens can be stratified by size based on simple measurements obtainable during routine pathology practice.

Adenocarcinoma↗
PubMed2000

The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system.

The Gleason grading system of prostatic adenocarcinoma does not account for the existence of a tertiary (third most prevalent) pattern, and there are no studies concerning the latter's prognostic influence. The authors analyzed 114 radical prostatectomies with small tertiary components, which mostly occupied less than 5% of whole tumors. These specimens were compared with a prostatectomy database comprised of 2,276 cases without a tertiary component. The pathologic stages of "typical" Gleason score 5 to 6 tumors (Gleason scores 2 + 3 = 5, 3 + 2 = 5, 3 + 3 = 6), which contained tertiary patterns 4 or 5, were significantly higher than those of "typical" Gleason score 5 to 6 tumors without pattern 4 (p = 0.018) but lower than those of "typical" Gleason score 7 tumors (p = 0.021; Gleason scores, 3 + 4 = 7, 4 + 3 = 7). Typical Gleason score 7 tumors with a tertiary pattern 5 showed significantly worse pathologic stages than typical Gleason score 7 tumors (p = 0.008) without pattern 5 and were not different statistically from typical Gleason score 8 (Gleason score, 4 + 4 = 8) tumors. Both typical Gleason score 5 to 6 and 7 tumors with tertiary components revealed significantly higher progression rates than typical Gleason score 5 to 6 tumors (p <0.0001) and Gleason score 7 tumors (p = 0.003) without tertiary components, and progressed like typical Gleason score 7 and 8 tumors respectively. Tertiary high-grade components have an adverse impact on biologic behavior. The authors propose that the Gleason system for radical prostatectomy specimens be modified to take into account small volumes of patterns 4 and 5, which are important prognostically.

Adenocarcinoma↗
PubMed2003

Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a Montsouris Institute.

PURPOSE: We performed a prospective oncological evaluation of laparoscopic radical prostatectomy in regard to local tumor control and biochemical recurrence. MATERIALS AND METHODS: Between January 1998 and March 2002, 1,000 consecutive patients with a mean age +/- SD of 63 +/- 6.2 years and clinically localized prostate cancer underwent laparoscopic radical prostatectomy at 1 institution. Preoperative 1997 TNM clinical stage was T1a in 6 patients (0.6%), T1b in 3 (0.3%), T1c in 660 (66.5%), T2a in 304 (30.4%) and T2b in 27 (2.7%). Mean preoperative prostate specific antigen (PSA) +/- SD was 10 +/- 6.1 ng./ml. (range 1.5 to 55). Postoperatively, surgical specimens were assessed and positive surgical margins recorded. Factors that could influence the surgical margins status were evaluated. Irrespective of pathological stage or surgical margin status, no adjuvant treatment was proposed before an increasing PSA. PSA recurrence was defined as PSA greater than 0.1 ng./ml. and was confirmed by a second increase. Recurrence time was defined as the time of the first increase in PSA. RESULTS: Postoperative pathological stage was pT2aN0/Nx in 203 patients (20.3%), pT2bN0/Nx in 572 (57.2%), pT3aN0/Nx in 142 (14.2%), pT3bN0/Nx in 77 (7.7%) and pT1-3 N1 in 6 (0.6%). Positive surgical margin rate was 6.9%, 18.6%, 30% and 34% for pathological stages pT2a, pT2b, pT3a and pT3b, respectively (p <0.001). The main predictors of a positive surgical margin were preoperative PSA (p <0.001), clinical stage (p = 0.001), pathological stage (p <0.001) and Gleason score (p = 0.003). The overall actuarial biochemical progression-free survival rate was 90.5% at 3 years. According to the pathological stage, the progression-free survival rate was 91.8% for pT2aN0/Nx, 88% for pT2bN0/Nx, 77% for pT3aN0/Nx, 44% for pT3bN0/Nx and 50% for pT1-3N1 (p <0.001). Of the patients 94% with negative surgical margins and 80% with positive margins had progression-free survival (p <0.001). Preservation of the neurovascular bundles in patients with localized tumors had no significant effect on the subsequent risk of positive surgical margins or progression-free survival. CONCLUSIONS: Based on followup, our evaluation confirms that laparoscopic radical prostatectomy provides satisfactory results in regard to local tumor control and biochemical recurrence.

Actuarial Analysis↗
PubMed2004

Feasibility of open simple prostatectomy with early vascular control.

OBJECTIVE: To determine the feasibility of open simple prostatectomy with early vascular control in the treatment of benign prostate hyperplasia (BPH), and thus reduce blood loss. PATIENTS AND METHODS: Thirty-seven patients were reviewed from 1991 to 2002; 34 had a Millin's and three a Freyer's prostatectomy performed by one surgeon, with early vascular control. RESULTS: The mean operative duration was 1.3 h and the mean blood loss 841 mL, with a mean decrease in haemoglobin level of 22 g/L. Six (16%) of the patients received a blood transfusion. The mean weight of the prostate removed was 97.8 g; the duration of catheterization and the hospital stay after surgery were 6.21 and 11.7 days, respectively. There was one (3%) death and one case of pulmonary embolism. Three patients (8%) developed stress incontinence. Two failed to void after surgery and one developed acute retention 3 years later. Five patients developed recurrent obstructive symptoms. CONCLUSION: Open simple prostatectomy with early vascular control reduces the amount of blood loss, rendering it a safe option for treating BPH.

Aged↗
PubMed2004

Phase I study of weekly mitoxantrone and docetaxel before prostatectomy in patients with high-risk localized prostate cancer.

PURPOSE: The purpose is to determine the dose-limiting toxicity (DLT) and maximum-tolerated dose (MTD) of mitoxantrone and docetaxel administered weekly before prostatectomy in men with localized prostate cancer at high risk for recurrence. EXPERIMENTAL DESIGN: Twenty-two patients were treated with four cycles of docetaxel 35 mg/m(2) and increasing doses of mitoxantrone starting at 2 mg/m(2) repeated weekly for 3 weeks of a 4-week cycle before prostatectomy. The MTD was defined as that dose at which fewer than one-third of patients experienced a DLT (>or=grade 4 hematological or >or=>grade 3 nonhematological toxicity). Changes in serum prostate-specific antigen and serum testosterone, and pathological outcome with surgery were secondary endpoints. RESULTS: The MTD for mitoxantrone in combination with this dose of docetaxel was 4 mg/m(2). Neutropenia was the DLT for the combination. Ten of 12 patients treated at the MTD completed the planned 16 weeks of chemotherapy, whereas 2 discontinued therapy early because of toxicity. The median reduction in PSA was 41% (range, 4-88%). Serum testosterone levels remained constant postchemotherapy. CONCLUSIONS: In this patient population, the planned Phase II regimen is 4 mg/m(2) mitoxantrone and 35 mg/m(2) docetaxel weekly for 3 of every 4 weeks. Delivery of this regimen before prostatectomy is feasible with acceptable toxicity. Additional studies are needed to determine whether this combined modality approach will reduce cancer recurrence rates in this high-risk population. Because extent of disease and exposure to prior therapy may impact treatment tolerance these safety data may not be applicable to patients with advanced prostate cancer.

Aged↗
PubMed2006

Early catheter removal following transurethral prostatectomy: a study of 431 patients.

OBJECTIVES: To assess and review catheter removal on the first day after transurethral prostatectomy. SUBJECTS AND METHODS: The study included 431 consecutive patients who underwent transurethral prostatectomy between 2000 and 2003 at a Scarborough General Hospital, Toronto, Canada. The equipment used was a standard resectoscope with a regular loop. No roller ball or other gadget was used. The cutting and coagulation electrical variables were standard at 160 and 60 W for the generator used. The decision to remove the catheters was based on normal vital signs, adequate urine output, absence of clots and acceptable color of the catheter effluent. RESULTS: Catheters were removed in 415 (96.3%) patients on postoperative day 1. Of the 415 patients 332 (80.0%) were discharged on the same day. The criteria for catheter removal on postoperative day 1 were not met in 16 (3.7%) patients and the mean indwelling catheter time was 4.8 +/- 2.4 days and the mean length of hospital stay after surgery was 6.2 +/- 3.3 days. For the entire group, the mean indwelling catheter time was 1.1 +/- 0.8 days and the mean length of hospital stay after surgery was 1.6 +/- 1.5 days. Risk factors which predicted delayed removal were age, postoperative bleeding and several comorbidities, that is coronary heart disease, renal insufficiency and Alzheimer's disease. CONCLUSIONS: Removal of the catheter on the first postoperative day after transurethral prostatectomy seems to be feasible, safe and cost-effective without increasing significant morbidity in selected patients.

Aged↗
PubMed2002

Venous thromboembolic prophylaxis for transurethral prostatectomy: practice among British urologists.

Venous thromboembolism (VTE) is an occasional cause of death after transurethral prostatectomy but there are no established guidelines for its prevention in relation to this operation. We assessed practice in the UK by mailing a questionnaire to 460 consultant members of the British Association of Urological Surgeons. 362 (79%) completed questionnaires were received. 280 of 362 (77%) respondents routinely used VTE prophylaxis with transurethral prostatectomy; 82 (23%) did not. 230 of the 280 urologists who took precautions used mechanical methods; 50 used low dose heparin, either with stockings or alone. This survey indicates that, despite a lack of clear evidence, most British urologists favour some form of precaution against VTE in patients undergoing transurethral prostatectomy.

Anticoagulants↗
PubMedDate not supplied

Rupture of vesicourethral anastomosis following radical retropubic prostatectomy.

OBJECTIVE: Rupture of vesicourethral anastomosis following radical retropubic prostatectomy is a complication that requires immediate management. We evaluated the morbidity of this rare complication. MATERIALS AND METHODS: We analyzed retrospectively 5 cases of disruption of vesicourethral anastomosis during post-operative period in a consecutive series of 1,600 radical retropubic prostatectomies, performed by a single surgeon. RESULTS: It occurred in a ratio of 1:320 prostatectomies (0,3%). Management was conservative in all the cases with an average catheter permanence time of 28 days, being its removal preceded by cystography. Two cases were secondary to bleeding, 1 followed the change of vesical catheter and 2 by unknown causes after removing the Foley catheter. Only one patient evolved with urethral stenosis, in the period ranging from 6 to 120 months. CONCLUSION: Rupture of vesicourethral anastomosis is not related to the surgeon's experience, and conservative treatment has shown to be effective.

Journal Article↗
PubMed2000

Effect of 13-cis-retinoic acid on serum prostate-specific antigen levels in patients with recurrent prostate cancer after radical prostatectomy.

The objective of this study was to determine whether there is any beneficial effect of oral 13-cis-retinoic acid (isotretinoin) on prostate cancer, using serum prostate-specific antigen (PSA) levels as a surrogate end point in patients with a rising serum PSA after radical prostatectomy. In the first phase, the effect of the drug on the serum PSA level was tested in 14 control patients with normal prostates. Our goal was to exclude any effect of isotretinoin on PSA secretion and metabolism and thus to validate any observed effect on PSA as indicative of anticancer activity. In the second phase, patients with rising PSA levels after radical prostatectomy and no evidence of metastatic disease were treated with oral isotretinoin at a daily dose of 1.0 mg/kg. Serum PSA levels were checked monthly for the first 4 months after initiation of treatment and every 3 months thereafter. No significant changes in serum PSA levels after 3 months of isotretinoin treatment were recorded in the control group (P = 1.000). Three of 11 postprostatectomy patients (27%) had a PSA reduction of 28%, 15%, and 6.6% after initiation of treatment that lasted for a period of 2-3 months. In two of these three patients, the PSA levels subsequently rose exponentially. Another patient displayed a stabilization of the serum PSA curve for 3 months after an initial sharp rise. No grade 3 or 4 toxicity was recorded in this group of patients. Isotretinoin had a modest, transient effect on the serum PSA level in 4 of 11 (36%) patients with a rising serum PSA after radical prostatectomy. We conclude that this drug is unlikely to be of major therapeutic benefit in prostate cancer patients when used as a single agent. However, its modest effect argues for the exploration of other, more potent retinoids for prostate cancer therapy.

Adult↗
PubMed2002

The efficacy and safety of perioperative low molecular weight heparin substitution in patients on chronic oral anticoagulant therapy undergoing transurethral prostatectomy for bladder outlet obstruction.

PURPOSE: Candidates for prostatectomy who require chronic anticoagulant therapy present a major perioperative management problem due to the threat of significant hemorrhage associated with surgery and the risk of thromboembolism associated with discontinuation of the anticoagulants. We evaluated prospectively a perioperative routine using low molecular weight heparin substitution to allow safe discontinuation of prophylactic oral anticoagulants in patients undergoing transurethral resection of the prostate. MATERIALS AND METHODS: We treated 20 patients on chronic oral anticoagulant therapy who required prostatectomy for bladder outlet obstruction according to a prospective protocol based on exchange of the oral anticoagulants with perioperative injections of low molecular weight heparin and resumption of oral anticoagulants early postoperatively. The safety and efficacy of this regimen were assessed in comparison to a control group comprised of 20 randomly selected nonwarfarin treated patients who underwent prostatectomy during the same period. RESULTS: The need for blood transfusions and mean number of units transfused did not significantly differ between the 2 groups. Due to persistent hematuria routine removal of the catheter was possible only in 9 of 20 patients (45%) in the heparin group compared to 18 of 20 (90%) in the control group. Average catheterization and hospitalization period in the heparin group was 3.2 days and 4.2 days respectively, compared to 2.1 and 2.1 days in the control group, respectively (p <0.01). No long-term hemorrhagic or thromboembolic complications were noted at 3 months postoperatively. CONCLUSIONS: Despite longer hospitalization in the heparin treated group, our substitution protocol is safe and effective.

Administration, Oral↗
PubMed2003

Early radical prostatectomy improves disease-specific but not overall survival.

For now, a reasonable strategy is to consider watchful waiting as an acceptable alternative to radical prostatectomy for patients with early prostate cancer and a lifespan of less than 10 years. For other patients, discuss the benefits and risks of the treatment options, balancing expected side effects of the operation and the impact of other illnesses on survival with the possible benefit of the operation or other kinds of treatment. We still lack sufficient evidence whether early detection by PSA screening can reduce morbidity or mortality. In this study, radical prostatectomy for early prostate cancer decreased disease-specific mortality, but did not improve overall mortality. A companion study (1) showed that non-nerve-sparing radical prostatectomy yielded no difference in subjective quality of life, although clinically important increases in erectile dysfunction (number needed to harm [NNH]=3) and urinary leakage (NNH=4) did occur, compared with watchful waiting. Clinicians should understand that these results might not apply to patients with highly undifferentiated cancer; patients identified by screening to have elevated prostate-specific antigen (PSA) concentrations and no clinically symptomatic disease; or patients with significant comorbidities.

Comment↗
PubMed1997

Radical perineal prostatectomy: a simplified approach.

Radical perineal prostatectomy (RPP) has been revisited by urologists in recent years, as preoperative staging has allowed identification of patients with low risk of nodal metastasis. Recent initiatives to contain hospital costs, as well as patient and physician concerns regarding use of the current blood supply, have led to development of less invasive and less morbid procedures. RPP has long been considered to be less morbid than radical retropubic prostatectomy (RRP). We present our technique of RPP. It has been used successfully in over 90 cases. This is a low risk and low morbidity procedure. There is markedly reduced blood loss, postoperative pain, and hospital stay, as compared to RRP. Positive margin rates are comparable using both techniques. Perineal prostatectomy should be considered an option for definitive treatment of localized prostatic carcinoma, when there is low probability of lymphatic involvement.

Journal Article↗